As a tobacco expert and the associate clinical director of health initiatives at National Jewish Health, Dr. Ylioja has been giving his thoughts on a slew of research that’s come out over the past few weeks regarding e-cigarettes.

Now, the “safer” claims marketed with e-cigarettes are being debated through various studies. While some experts point to e-cigarettes as a way to help people stay off traditional cigarettes, others point to potential increases in diseases associated with them, such as stroke and other cardiovascular diseases.

One study published in the The New England Journal of Medicine examined where e-cigarettes may fit in with smoking cessation. Ylioja called the research a “well done” paper with its randomized design of 886 participants.

The study concluded that after one year of choosing a therapy, 18 percent of those who used e-cigarettes were still smoke-free, compared to the almost 10 percent who used non-inhalable nicotine delivery methods such as patches, gums, or lozenges.

But there’s one thing about the study that stood out to Ylioja: 80 percent of e-cigarette users were still using the devices a year after the study began, compared to the 9 percent still using the other methods.

And people who use e-cigarettes are more likely to use the products while still smoking typically where vaping is allowed and smoking isn’t, he said.

As Healthline recently reported, more states, counties, and cities are lumping e-cigarettes in with the traditional ones and banning them both indoors and in some outdoor public places.

Ylioja argues that because e-cigarettes are more discreet, they’re reversing progress made on eliminating places were smokers can smoke. The fewer opportunities there are for someone to inhale nicotine, the reasoning goes, the more likely they are to quit nicotine altogether.

“You’re not raising the bar very high if it’s safer than smoking tobacco,” Ylioja said.

He notes, in particular, the “volume of toxic chemicals” emitted from burning tobacco.

The American Heart Association (AHA) recently released the findings of a study at the AHA International Stroke Conference 2019 in Honolulu.

Calling it “the largest study to date examining e-cigarettes and stroke,” researchers used responses from about 400,000 people in the 2016 behavioral risk factor surveillance system survey. Nearly 67,000 people reported using e-cigarettes at some point while the rest hadn’t.

“Compared with non-users, e-cigarette users were younger, had a lower body mass index, and a lower rate of diabetes,” Paul M. Ndunda, MD, the study’s author and an assistant professor in the School of Medicine at the University of Kansas, said in a statement.

In other words, they had attributes that made them less likely to have cardiovascular-related problems, yet e-cigarette users still had higher risks of diseases often associated with smoking.

One was a 71 percent higher risk of stroke, as 4.2 percent of e-cigarette users reported having one. Other key findings include a nearly 60 percent increased likelihood of having a heart attack and 40 percent increase in risk of developing coronary heart disease.

The study also found that e-cigarette users had double the rate of smoking traditional combustible cigarettes.

However, the research was presented at a conference and has yet to appear in a peer-reviewed journal. This has some experts questioning its findings.

Pat Folan, director of the Center for Tobacco Control at Northwell Health, says while studies like these can be useful because they could identify associations that can then be studied “using a more rigorous scientific method.”

“The problem with these types of studies is the difficulty in determining cause and effect rather than a simple association,” Folan told Healthline. “I’m not sure from reading this study if the e-cigarette users were also current or former smokers, which would’ve put them in a high category for stroke, heart attack, and diseased arteries whether or not they’d used e-cigarettes.”

Mark Ortiz, founder of the e-cigarette fluid company Belivio, also takes issue with the study not separating out e-cigarette users who didn’t smoke, saying “the study isn’t completely genuine.”

“It’s fair to say that build-up of tar from cigarette smoking is only further worsened by the use of e-cigs due to the inflammation properties of e-cig use,” he told Healthline. “I really do believe that the study needs to run this research on individuals that only use e-cigs to properly assess the health issues.”

Because e-cigarettes have only been on the market since 2004, the long-term effects of their use are still unknown. Claims that they are safer come from the manufacturers of those products, Folan says.

“But we don’t have the scientific data yet indicating that they’re safe and effective — or even safer — for smoking cessation,” Folan said. “Many of them contain several cancer-causing chemicals, flavorings, and high levels of nicotine.”

In December, Surgeon General Jerome Adams issued an advisory of the “epidemic of youth e-cigarette use.” He cited federal data that showed that last year 75 percent of high school-aged children reported using an e-cigarette in the past 30 days.

“We need to protect our kids from all tobacco products, including all shapes and sizes of e-cigarettes,” Adams said in a statement.

Overall, Ylioja says the National Jewish Health’s guidelines is to not recommend e-cigarettes for people who are trying to quit smoking.

That’s because they’re not approved for smoking cessation by the Food and Drug Administration (FDA), which currently regulates e-cigarettes as another tobacco product.

“It doesn’t help them quit nicotine,” Ylioja said of e-cigarettes.

The organization instead recommends the “gold standard” in helping people quit smoking: nicotine replacement therapies such as gums, patches, and lozenges, along with behavioral counseling.

Folan says Northwell Health uses that same type of standard of care, coupling FDA-approved smoking cessation medications with supportive coaching and various forms of counseling, which can double and triple success rates for quitting.

“If a person wants to use e-cigarettes, we’ll still work with them to reach their goal of quitting,” Folan said. “Some people have used e-cigarettes but find themselves smoking traditional cigarettes and e-cigarettes. They usually ask for help to quit both.”